Provider Demographics
NPI:1265499651
Name:SCHLEDORN, MEREDITH A (PA)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:A
Last Name:SCHLEDORN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:A
Other - Last Name:SIEGMUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2077
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-2077
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2121 NE 139TH ST STE 430
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2316
Practice Address - Country:US
Practice Address - Phone:360-487-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA178408363A00000X
NY010972363A00000X
WAPA60449763363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02690393Medicaid
NYPA0972Medicare PIN